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Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults

Por: Luo · Y. · Zhang · L. · He · P. · Pang · L. · Guo · C. · Zheng · X.
Objectives

Health disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally large representative data, this study investigated the association between individual-level SES, area-level SES and their interaction with schizophrenia in Chinese adults from a multilevel perspective.

Setting

Household interviews in 734 counties (districts), 2980 towns (streets) and 5964 communities (villages) from 31 provinces, People's Republic of China, as part of the cross-sectional survey of Second China National Sample Survey on Disability.

Participants

1 909 205 men and women aged 18 years old and above.

Primary and secondary outcome measures

A screen followed by clinical diagnosis was used to identify schizophrenia, and schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision (code F20).

Results

1-SD increase in individual SES was associated with decreased risk of schizophrenia (OR=0.45, 95% CI 0.43 to 0.46). 1-SD increase in area-level SES was associated with increased risk of schizophrenia (OR=1.30, 95% CI 1.24 to 1.37). The interaction of individual SES and area-level SES was statistically significant (OR=1.05, 95% CI 1.02 to 1.08); as the level of area SES increased, schizophrenia risk of lower SES people grew faster than the risk of higher SES people.

Conclusions

Area-level SES is particularly important to mental health of low SES individuals, with low SES people in high SES counties having the highest risk of schizophrenia than other groups. Action to reduce SES disparities in schizophrenia will require attention to the area-level context of low SES adults.

Effects of foliar application of amino acid liquid fertilizers, with or without <i>Bacillus amyloliquefaciens</i> SQR9, on cowpea yield and leaf microbiota

by Dongsheng Wang, Xuhui Deng, Bei Wang, Na Zhang, Chengzhi Zhu, Zixuan Jiao, Rong Li, Qirong Shen

Leaf surface fertilization with liquid fertilizer produced from amino acids constitutes a potentially important source of nitrogen and is important for plant production. However, few reports have focused on the plant growth promotion by novel liquid fertilizers created by new amino acid resources, let alone the influence on leaf microbiota. In this study, the effects of liquid fertilizer, created by amino acids hydrolyzed from animal hairs with or without the PGPR strain Bacillus amyloliquefaciens SQR9, on crop yield and leaf microbiota were investigated. The results showed that leaves sprayed with amino acid liquid fertilizer (AA) and liquid biological fertilizer (AA9) persistently increased cowpea yields compared to the control amended with chemical fertilizer (CF). Fertilization with amino acid fertilizer showed no significant difference in microbial composition compared with the CF treatment; however, the introduction of functional microbes altered the microbial composition. Pearson correlation analysis, VPA analysis and SEM models all revealed that the amino acids liquid fertilizer application, but not the functional strain or the altered microbiota, performed as the direct driver attributing to yield enhancement. We conclude that leaf fertilization with a novel amino acid liquid fertilizer can greatly enhance the crop yield and that the addition of beneficial microbes may perform the role in further altering the composition of leaf microbiota.

The prevalence and influencing factors of physical activity and sedentary behaviour in the rural population in China: the Henan Rural Cohort Study

Por: Tu · R. · Li · Y. · Shen · L. · Yuan · H. · Mao · Z. · Liu · X. · Zhang · H. · Zhang · L. · Li · R. · Wang · Y. · Wang · Y. · Wang · C.
Objectives

To estimate the prevalence and influencing factors of physical activity (PA) and sedentary behaviour (SB) in rural areas of China.

Design

Cross-sectional study.

Setting

A multistage, stratified cluster sampling method was used to obtain samples in the general population of Henan province in China.

Participants

38 515 participants aged 18–79 years were enrolled from the Henan Rural Cohort Study for the cross-sectional study.

Main outcome measures

The International Physical Activity Questionnaire was used to assess the levels of PA and SB. Multiple logistic regression analysis was used to calculate ORs and 95% CIs of potential influencing factors with physical inactivity.

Results

The age-standardised prevalence of light PA and sitting >7.5 hours per day were 32.74% and 26.88% in the general Chinese rural adults, respectively. Gender differences were: 34.91%, 29.76% for men and 31.75%, 25.16% for women, respectively. The prevalence of participants with both light PA and sitting >7.5 hours per day was 13.95%. Education at least junior middle school, divorced/widowed/unmarried, RMB1000> per capita monthly income ≥RMB500, sitting >7.5 hours per day were negatively associated with light PA. For sitting >7.5 hours per day, the negative factors were being men, divorced/widowed/unmarried, heavy smoking, Fishery products, vegetable and fruits intake .

Conclusion

Physical inactivity and SB were high in rural China. There is an increased need to promote a healthy lifestyle to the rural population.

Clinical trial registration

The Henan Rural Cohort Study has been registered with the Chinese Clinical Trial Register.

Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375

A coordinated preventive care approach for healthy ageing in five European cities: a mixed‐methods study of process evaluation components

Abstract

Aims

To evaluate specific process components of the Urban Health Centres Europe approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain.

Design

Mixed‐methods evaluation of specific process components of the Urban Health Centres Europe approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach.

Methods

The Urban Health Centres Europe approach intervention consisted of a preventive assessment, shared‐decision making on a care plan and enrolment in one or more of four coordinated care‐pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus‐groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis.

Results

Having limited function was associated with non‐enrolment in falls and loneliness care‐pathways (both P<0.01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care.

Conclusions

Although the Urban Health Centres Europe approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care.

Impact

coordinated preventive care approaches for older community‐dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care.

This article is protected by copyright. All rights reserved.

Relationship between gay app use and HIV testing among men who have sex with men in Shenzhen, China: a serial cross-sectional study

Por: Wei · L. · Chen · L. · Zhang · H. · Yang · Z. · Liu · S. · Tan · W. · Xie · W. · Liu · L. · Zhao · J. · Cheng · J.
Objectives

To investigate the relationship between gay app use and HIV testing among men who have sex with men (MSM).

Design

Serial cross-sectional study.

Setting

A newly well-developed city in China.

Participants

4935 MSM were recruited through offline sampling methods from 2015 to 2017.

Primary and secondary outcomes

The primary outcome is the difference in HIV testing between app and non-app users.

Results

2872 (58.2%) and 2159 (43.7%) participated MSM had been tested for HIV within lifetime and the past year, respectively. Compared with non-app-using MSM, app-using MSM had a significantly higher prevalence of HIV testing within lifetime (adjusted OR (AOR): 1.48, 95% CI 1.27 to 1.72) and the past year (AOR: 1.36, 95% CI 1.18 to 1.57). App-using MSM were more likely to take an HIV test at the Centers for Disease Control and Prevention (AOR: 1.48, 95% CI 1.24 to 1.76) and community-based organisations (AOR: 1.71, 95% CI 1.44 to 2.03), but less often at gay venues (AOR: 0.49, 95% CI 0.37 to 0.63). Meanwhile, app-using MSM were more likely to take self-testing (AOR: 1.61, 95% CI 1.21 to 2.14). Predictors of HIV testing in the past year were: having an education level of college or higher (AOR: 1.29, 95% CI 1.01 to 1.65), being self-identified as a homosexual (AOR: 1.23, 95% CI 1.02 to 1.46), being recruited through clinic-based sampling (AOR: 1.30, 95% CI 1.06 to 1.60), using gay app (AOR: 1.49, 95% CI 1.21 to 1.83), engaging in group sex (AOR: 1.64, 95% CI 1.23 to 2.19), having received HIV-related service (AOR: 5.49, 95% CI 4.57 to 6.60), having a high level of HIV-related knowledge (AOR: 1.33, 95% CI 1.10 to 1.61) and high-risk perception (AOR: 2.95, 95% CI 1.40 to 6.23).

Conclusions

Gay app use was significantly associated with increased HIV testing among MSM hard to reach by traditional outreach. Therefore, it is imperative to expand HIV testing among non-app-using MSM. Continued efforts, innovative strategies and increased resource are highly needed to realise the first ‘90’ target.

Risk factors for new ischaemic cerebral lesions after carotid artery stenting: protocol for a systematic review and meta-analysis

Por: Feng · Y. · Li · L. · Bai · X. · Wang · T. · Chen · Y. · Zhang · X. · Ling · F. · Jiao · L.
Introduction

New ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS.

Methods and analysis

All relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case–control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2 statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Ethics and dissemination

There is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals.

PROSPERO registration number

CRD42019121129

Epidemiological characteristics of elevated blood pressure among middle and high school students aged 12-17 years: a cross-sectional study in Jiangsu Province, China, 2017-2018

Por: Zhang · X. · Yang · J. · Wang · Y. · Liu · W. · Yang · W. · Gao · L. · Schwertz · R. · Welker · A. · Zhang · F. · Zhou · Y.
Objective

In this study, we aimed to present the epidemiological characteristics of elevated blood pressure among middle and high school students aged 12–17 years in Jiangsu Province.

Setting

Hypertension, which is considered a rare disease in children, is an important early precursor to long-term cardiovascular damage, and elevated blood pressure in childhood is a strong predictor of hypertension in adulthood.

Participants

Physical examination and questionnaire investigation among children aged 12–17 years in Jiangsu Province were conducted from 2017 to 2018.

Main outcome measures

Physical measurements included height, weight, blood pressure and history of menarche/first spermatorrhoea. Questionnaire investigation included family type, delivery mode, lifestyle habits and psychological test.

Results

In our study we investigated 17 791 middle and high school students, consisting of 8701 female students and 9090 male students. The prevalence of screening elevated blood pressure among students aged 12–17 years was 20.0% (95% CI 19.2% to 20.9%) for female students and 22.3% (95% CI 21.5% to 23.2%) for male students. The prevalence of screening elevated blood pressure for urban male middle and high school students was higher than that of elevated blood pressure for rural male middle and high school students. However, similar phenomenon cannot be observed among female students. For both male and female students, body mass index (BMI), obesity/overweight and menarche/first spermatorrhoea can be a risk factor contributing to elevated blood pressure, and sleep time and regional distribution might be important factors that need to be investigated in depth.

Conclusion

We found a relatively high prevalence of screening elevated blood pressure among students aged 12–17 years for both female and male students in Jiangsu Province. The risk factors can be BMI, obesity/overweight and menarche/first spermatorrhoea.

An exploratory spatial analysis of overweight and obesity among children and adolescents in Shandong, China

Por: Qin · W. · Wang · L. · Xu · L. · Sun · L. · Li · J. · Zhang · J. · Shao · H.
Objective

Identifying the spatial patterns of childhood overweight/obesity (OW/OB) can help to guide resource allocation for preventive intervention in China. This study aims to estimate rates of childhood OW/OB across counties within Shandong Province, using geographic techniques to identify sex-specific spatial patterns of childhood OW/OB as well as the presence of spatial clusters.

Design

Cross-sectional study.

Setting

Shandong Province in China.

Participants and methods

Data on 6 216 076 children and adolescents aged 7–18 years from the Primary and Secondary Schoolchildren Physical Examination Database for Shandong Province were used in this study. Spatial patterns of sex-specific prevalence of childhood OW/OB were mapped. Global autocorrelation statistic (Moran’s I) and the Local Indicator of Spatial Association (LISA) were applied to assess the degree of spatial autocorrelation.

Results

The overall prevalence of childhood OW/OB in Shandong province were 15.05% and 9.23%, respectively. Maps of the sex-specific prevalence of OW/OB demonstrate a marked geographical variation of childhood OW/OB in different regions. Prevalence of childhood OW/OB had a significant positive spatial autocorrelation among both boys and girls. LISA analysis identified significant clusters (or ‘hot spots’) of childhood OW/OB in the eastern coastal region, central region and southwestern region.

Conclusions

The prevalence of childhood OW/OB is highly spatially clustered. Geographically focused appropriate intervention should be introduced in current childhood OW/OB prevention and control strategy.

Association between educational level and total and cause-specific mortality: a pooled analysis of over 694 000 individuals in the Asia Cohort Consortium

Por: Yang · K. · Zhang · Y. · Saito · E. · Rahman · M. S. · Gupta · P. C. · Sawada · N. · Tamakoshi · A. · Gao · Y.-T. · Koh · W.-P. · Shu · X.-O. · Tsuji · I. · Sadakane · A. · Nagata · C. · You · S.-L. · Yuan · J.-M. · Shin · M.-H. · Chen · Y. · Pan · W.-H. · Pednekar · M. S. · Tsugane · S. · Cai
Objective

To study the association of educational level and risk of death from all causes, cardiovascular disease (CVD) and cancer among Asian populations.

Design

A pooled analysis of 15 population-based cohort studies.

Setting and participants

694 434 Asian individuals from 15 prospective cohorts within the Asia Cohort Consortium.

Interventions

None.

Main outcome measures

HRs and 95% CIs for all-cause mortality, as well as for CVD-specific mortality and cancer-specific mortality.

Results

A total of 694 434 participants (mean age at baseline=53.2 years) were included in the analysis. During a mean follow-up period of 12.5 years, 103 023 deaths were observed, among which 33 939 were due to cancer and 34 645 were due to CVD. Higher educational levels were significantly associated with lower risk of death from all causes compared with a low educational level (≤primary education); HRs and 95% CIs for secondary education, trade/technical education and ≥university education were 0.88 (0.85 to 0.92), 0.81 (0.73 to 0.90) and 0.71 (0.63 to 0.80), respectively (ptrend=0.002). Similarly, HRs (95% CIs) were 0.93 (0.89 to 0.97), 0.86 (0.78 to 0.94) and 0.81 (0.73 to 0.89) for cancer death, and 0.88 (0.83 to 0.93), 0.77 (0.66 to 0.91) and 0.67 (0.58 to 0.77) for CVD death with increasing levels of education (both ptrend

Conclusion

Higher educational level was associated with substantially lower risk of death among Asian populations.

Physical activity, sedentary time and their associations with clustered metabolic risk among people with type 2 diabetes in Jiangsu province: a cross-sectional study

Por: Chen · Y. · Yang · J. · Su · J. · Qin · Y. · Shen · C. · Li · Y. · Lu · S. · Pan · E. · Gao · Y. · Miao · D. · Zhang · N. · Zhou · J. · Wu · M.
Objective

Investigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China.

Design

Interview-based cross-sectional study conducted between December 2013 and January 2014.

Setting

44 selected townships across two cities, Changshu and Huai’an, in Jiangsu province.

Participants

20 340 participants selected using stratified cluster-randomised sampling and an interviewer-managed questionnaire.

Methods

We constructed clustered metabolic risk by summing sex-specific standardised values of waist circumference, fasting triacylglycerol, fasting plasma glucose, systolic blood pressure and the inverse of blood high-density lipoprotein cholesterol (HDL-cholesterol). Self-reported total physical activity included occupation, commuting and leisure-time physical activity. The un-standardised regression coefficient [B] and its 95% CI were calculated using multivariate linear regression analyses.

Results

This study included 17 750 type 2 diabetes patients (aged 21–94 years, 60.3% female). The total (B=–0.080; 95% CI: –0.114 to –0.046), occupational (B=–0.066; 95% CI: –0.101 to– 0.031) and leisure-time physical activity (B=–0.041; 95% CI: –0.075 to –0.007), and sedentary time (B=0.117; 95% CI: 0.083 to 0.151) were associated with clustered metabolic risk. Total physical activity, occupational physical activity and sedentary time were associated with waist circumference, triacylglycerol and HDL-cholesterol, but not with systolic blood pressure. Commuting physical activity and sedentary time were significantly associated with triacylglycerol (B=–0.012; 95% CI: –0.019 to –0.005) and fasting plasma glucose (B=0.008; 95% CI: 0.003 to 0.01), respectively. Leisure-time physical activity was only significantly associated with systolic blood pressure (B=–0.239; 95% CI: –0.542 to– 0.045).

Conclusions

Total, occupational and leisure-time physical activity were inversely associated with clustered metabolic risk, whereas sedentary time increased metabolic risk. Commuting physical activity was inversely associated with triacylglycerol. These findings suggest that increased physical activity in different domains and decreased sedentary time may have protective effects against metabolic risk in type 2 diabetes patients.

Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies

Por: Lai · S. · Peng · P. · Diao · T. · Hou · H. · Wang · X. · Zhang · W. · Liu · M. · Zhang · Y. · Seery · S. · Wang · J.
Objective

To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Design

Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

Data sources

PubMed, EMBASE, the Cochrane Library until October 2018.

Eligibility criteria

Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.

Data extraction and synthesis

Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).

Results

22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p

Conclusion

PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.

Impact of depression on clinical outcomes following percutaneous coronary intervention: a systematic review and meta-analysis

Por: Zhang · W. Y. · Nan · N. · Song · X. T. · Tian · J. F. · Yang · X. Y.
Objectives

The objective of this meta-analysis was to assess whether depression in percutaneous coronary intervention (PCI) patients is associated with higher risk of adverse outcomes.

Design

Systematic review and meta-analysis.

Methods

EMBASE, PubMed, CINAHL and PsycINFO were searched as data sources. We selected prospective cohort studies evaluating the relationship between depression and any adverse medical outcome, including all-cause mortality, cardiac mortality and non-fatal events, from inception to 28 February 2019. Two reviewers independently extracted information and calculated the risk of cardiovascular events in patients with preoperative or postoperative depression compared with non-depressed patients.

Results

Eight studies (n=3297) met our inclusion criteria. Most studies found a positive association between depression and adverse cardiovascular outcomes. Meta-analysis yielded an aggregate risk ratio of 1.57 (95% CI 1.28 to 1.92, p

Conclusions

Our systematic review and meta-analysis suggests that depression is associated with an increased risk of worse clinical outcome or mortality in patients undergoing PCI. Assessment time and length of follow-up do not have a significant effect on this conclusion.

Relationship between metabolic syndrome and its components and cardiovascular disease in middle-aged and elderly Chinese population: a national cross-sectional survey

Por: Li · W. · Song · F. · Wang · X. · Wang · D. · Chen · D. · Yue · W. · Zhang · H. · Wang · Z. · Lu · Z.
Objectives

To assess the relationship between metabolic syndrome (MetS) and its components and cardiovascular disease (CVD) according to different criteria of MetS, as well as whether the estimated association between MetS and CVD was affected by different definitions of MetS among the Chinese population.

Design

Population-based, cross-sectional study.

Setting

Data were from a large-scale national stroke screening survey, China National Stroke Screening and Prevention Project.

Participants

A nationally representative sample of 109 551 Chinese adults aged ≥40 years in 2014–2015 were included.

Primary outcome measures

CVD conditions (stroke, coronary heart disease (CHD) and atrial fibrillation (AF)) diagnosed by clinicians were self-reported.

Results

ORs after adjusting for CHD, stroke, AF and CVD in those with MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criterion were 1.56 (95% CI 1.48 to 1.63), 1.23 (95% CI 1.17 to 1.30), 1.14 (95% CI 1.08 to 1.21) and 1.40 (95% CI 1.35 to 1.45); 1.51 (95% CI 1.44 to 1.58), 1.20 (95% CI 1.14 to 1.26), 1.09 (95% CI 1.04 to 1.15) and 1.34 (95% CI 1.29 to 1.38) with the American Heart Association/National Heart, Lung, and Blood Institute criterion; and 1.41 (95% CI 1.35 to 1.48), 1.24 (95% CI 1.19 to 1.30), 1.12 (95% CI 1.06 to 1.18) and 1.31 (95% CI 1.27 to 1.35) with the International Diabetes Federation criterion, respectively. Elevated blood pressures were all highly related to the prevalence of stroke and AF, and reduced high-density lipoprotein-cholesterol was associated with a higher OR for CHD than other individual components of MetS.

Conclusions

MetS is significantly associated with CVD, and the prevalence of CVD was more evident when MetS was defined according to the NCEP ATP III criterion. Developing effective public health strategies for the prevention, detection and treatment of MetS should be an urgent priority to reduce the burden of CVD in China.

Prevalence and patterns of multimorbidity among the elderly in China: a cross-sectional study using national survey data

Por: Zhang · R. · Lu · Y. · Shi · L. · Zhang · S. · Chang · F.
Objectives

Examination of the prevalence and patterns of multimorbidity among the elderly in China.

Design

Cross-sectional study.

Setting

More than 10 000 households in 28 of the 34 provinces of mainland China.

Participants

11 707 Chinese adults aged 60 and over.

Primary outcome measures

Prevalence and patterns of multimorbidity among the participants. Relative risks were calculated to estimate the probability of up to 14 chronic conditions coexisting with each other. Observed-to-expected (O/E) ratios were used to analyse the patterns of multimorbidity.

Results

Multimorbidity was present in 43.6% of respondents from the sample population, with women having the greater prevalence compared with men. There were 804 different comorbidity combinations identified, including 76 dyad combinations and 169 triad combinations. The top 10 morbidity dyads and triads accounted for 69.01% and 47.05% of the total dyad and triad combinations observed, respectively. Among the 14 chronic conditions included in the study, asthma, stroke, heart attack and six other chronic conditions were the main components of multimorbidity due to their high relative risk ratios. The most frequently occurring clusters with higher O/E ratios were stroke along with emotional, nervous, or psychiatric problems; memory-related diseases together emotional, nervous, or psychiatric problems; and memory-related diseases and asthma accompanied by chronic lung diseases and asthma.

Conclusions

The results of this study highlight the high prevalence of multimorbidity in the elderly population in China. Further studies are required to understand the aetiology of multimorbidity, and future primary healthcare policies should be made while taking multimorbidity into consideration.

Effect of computerised cognitive training on cognitive outcomes in mild cognitive impairment: a systematic review and meta-analysis

Por: Zhang · H. · Huntley · J. · Bhome · R. · Holmes · B. · Cahill · J. · Gould · R. L. · Wang · H. · Yu · X. · Howard · R.
Objectives

To determine the effect of computerised cognitive training (CCT) on improving cognitive function for older adults with mild cognitive impairment (MCI).

Design

Systematic review and meta-analysis.

Data sources

PubMed, Embase, Web of Science and the Cochrane Library were searched through January 2018.

Eligibility criteria

Randomised controlled trials comparing CCT with control conditions in those with MCI aged 55+ were included.

Data extraction and synthesis

Two independent reviewers extracted data and assessed the risk of bias. Effect sizes (Hedges’ g and 95% CIs) were calculated and random-effects meta-analyses were performed where three or more studies investigated a comparable intervention and outcome. Heterogeneity was quantified using the I2 statistic.

Results

18 studies met the inclusion criteria and were included in the analyses, involving 690 participants. Meta-analysis revealed small to moderate positive treatment effects compared with control interventions in four domains as follows: global cognitive function (g=0.23, 95% CI 0.03 to 0.44), memory (g=0.30, 95% CI 0.11 to 0.50), working memory (g=0.39, 95% CI 0.12 to 0.66) and executive function (g=0.20, 95% CI –0.03 to 0.43). Statistical significance was reached in all domains apart from executive function.

Conclusions

This meta-analysis provides evidence that CCT improves cognitive function in older people with MCI. However, the long-term transfer of these improvements and the potential to reduce dementia prevalence remains unknown. Various methodological issues such as heterogeneity in outcome measures, interventions and MCI symptoms and lack of intention-to-treat analyses limit the quality of the literature and represent areas for future research.

Changing incidence of reported viral hepatitis in China from 2004 to 2016: an observational study

Por: Zhang · M. · Wu · R. · Xu · H. · Uhanova · J. · Gish · R. · Wen · X. · Jin · Q. · Gerald · M. Y. · Nguyen · M. H. · Gao · Y. · Niu · J.
Objective

China’s national hepatitis burden is high. This study aims to provide a detailed national-level description of the reported incidence of viral hepatitis in China during 2004–2016.

Design

Observational study.

Setting

Data were obtained from China’s National Notifiable Disease Reporting System, and changing trends were estimated by joinpoint regression analysis.

Participants

In this system, 16 927 233 reported viral hepatitis cases occurring during 2004–2016 were identified.

Primary outcome measure

Incidence rates per 100 000 person-years and changing trends were calculated.

Results

There were 16 927 233 new cases of viral hepatitis reported in China from 2004 to 2016. Hepatitis B (HBV) (n=13 543 137, 80.00%) and hepatitis C (HCV) (n=1 844 882, 10.90%) accounted for >90% of the cases. The overall annual percent change (APC) in reported cases of viral hepatitis and HBV were 0.3%(95% CI –2.0 to 0.8, p=0.6) and –0.2% (95% CI –1.6 to 1.2, p=0.8), respectively, showing a stable trend. HBV rates were highest in the 20–29 year old age group and lowest in younger individuals, likely resulting from the universal HBV vaccination. The reported incidence of HCV and hepatitis E (HEV) showed increasing trends; the APCs were 14.5% (95% CI 13.1 to 15.9, p

Conclusions

HBV continues to constitute the majority of viral hepatitis cases in China. Over the entire study period, the HBV reporting incidence was stable, the HCV and HEV incidence increased and the HAV incidence decreased. There were significant interprovincial disparities in the burden of viral hepatitis, with higher rates in economically less-developed areas. Vaccination is important for viral hepatitis prevention and control.

Knowledge acquisition and retention following Saving Childrens Lives course for healthcare providers in Botswana: a longitudinal cohort study

Por: Meaney · P. A. · Joyce · C. L. · Setlhare · S. · Smith · H. E. · Mensinger · J. L. · Zhang · B. · Kalenga · K. · Kloeck · D. · Kgosiesele · T. · Jibril · H. · Mazhani · L. · de Caen · A. · Steenhoff · A. P.
Objectives

Millions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children’s Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for providers who treat serious childhood illnesses. The objective of this study was to examine the impact of SCL-aHIT on knowledge acquisition and retention of providers.

Setting

76 participating centres who provide primary and secondary care in Kweneng District, Botswana.

Participants

Doctors and nurses expected by the District Health Management Team to provide initial care to seriously ill children, completed SCL-aHIT between January 2014 and December 2016, submitted demographic data, course characteristics and at least one knowledge assessment.

Methods

Retrospective, cohort study. Planned and actual primary outcome was adjusted acquisition (change in total knowledge score immediately after training) and retention (change in score at 1, 3 and 6 months), secondary outcomes were pneumonia and dehydration subscores. Descriptive statistics and linear mixed models with random intercept and slope were conducted. Relevant institutional review boards approved this study.

Results

211 providers had data for analysis. Cohort was 91% nurses, 61% clinic/health postbased and 45% pretrained in Integrated Management of Childhood Illness (IMCI). A strong effect of SCL-aHIT was seen with knowledge acquisition (+24.56±1.94, p

Conclusions

aHIT for care of the seriously ill child significantly increased provider knowledge and loss of knowledge occurred over time. IMCI training did not significantly impact overall knowledge acquisition nor retention, while professional status impacted overall score and lost to follow-up impacted retention.

Gender differences in factors associated with depression in infertility patients

Abstract

Aims

To clarify gender differences in the demographic variables and infertility problems associated with depression among men and women undergoing infertility treatment.

Design

A cross‐sectional study.

Methods

We surveyed 380 women and 360 men undergoing infertility treatment at the reproductive medicine center of a hospital in China's Ningxia Province from March ‐ September 2016.

Results

For women, ethnicity, the number of clinic visits, social concern and sexual concern were factors linked with depression symptoms. For men, treatment cost pressure and social concern were significantly associated with depression symptoms.

Conclusion

Psychological counseling and intervention programs should be integrated into in‐vitro fertilization treatments and interventions should be targeted based on gender differences.

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Comparison of early and delayed invasive strategies in short-medium term among patients with non-ST segment elevation acute coronary syndrome: A systematic review and meta-analysis

by Ming-Bo Zhang, Chen Guo, Min Li, Yong-Hui Lv, Yu-Dong Fan, Zhi-Lu Wang

Background and objectives

An invasive approach is recommended as the treatment of patients with non-ST elevated acute coronary syndromes (NSTE-ACS). However, it remains unclear that the optimal time of angiography and intervention for patients with NSTE-ACS at present. This study was designed to compare the effect of early and delayed invasive strategies on short-medium term prognosis in patients with those.

Methods

Pubmed, Cochrane Library and Embase were searched up to Dec-30-2018. Randomized clinical trials comparing an early versus a delayed invasive strategy in patients with NSTE-ACS were included. The primary endpoint (all-cause death and recurrent myocardial infarction) and secondary endpoint (major bleeding and recurrent revascularization), as well as composite endpoint were assessed by random or fixed effected meta-analysis with software RevMan 5.3 version after short-medium term follow up.

Result

A total of six randomized clinical trials involving 4,277 early or delayed invasive strategies patients with NSTE-ACS were included in the meta-analysis. Time to coronary angiography varied from 0.5 to 24 h in the early invasive strategy and from 18.6 to 72 h in the delayed invasive strategy. There was a statistical difference in the primary endpoint of all-cause death among patients with NSTE-ACS between early and delayed invasive strategies (4.6% vs 6%; OR:0.76; 95% CI:0.58 to 1.00; P = 0.05; I2 = 0%), but not for recurrent myocardial infarction (6.0% vs 6.3%; OR: 0.94; 95% CI: 0.55 to 1.61; P = 0.82; I2 = 60%). The major bleeding in patients with NSTE-ACS was similar between both invasive strategies (2.7% vs 3.1%; OR:0.88; 95% CI:0.59 to 1.31; P = 0.54; I2 = 0%). However, the composite endpoint in the early invasive strategy patients with NSTE-ACS was significantly lower than that of the delayed invasive strategy (10.9% vs 13.9%; OR:0.76; 95% CI:0.63 to 0.92; P = 0.006; I2 = 0%), and the recurrent revascularization between both strategies was just the opposite (8.7% vs 5.9%; OR:1.5; 95%CI:1.15 to 1.97; P = 0.003; I2 = 0%).

Conclusion

The systematic review and meta-analysis demonstrated that the early invasive strategy had a beneficial trend on all-cause death and significantly reduced the composite endpoint in patients with NSTE-ACS, but increased the rate of revascularization. These data could provide a solution for patients with those.

Inflammatory cytokines via up-regulation of aquaporins deteriorated the pathogenesis of early osteoarthritis

by Chunjiang Tan, Jiahui Zhang, Wenlie Chen, Fangfang Feng, Chao Yu, Xiaodong Lu, Ruhui Lin, Zuanfang Li, Yunmei Huang, Liangpu Zheng, Meiya Huang, Guangwen Wu

Background

Inflammatory cytokines enhanced the progress of the pathogenesis of osteoarthritis, however the mechanisms remain unclear. The objective is to determine aquaporins (AQPs) in the pathogenesis of osteoarthritis.

Methods and findings

Primary rat articular chondrocytes were treated with IL-1β to mimic the early stage of osteoarthritis in vitro. Early osteoarthritis animal model was established by intra-articular injection of 4% papain. Micro- or ultra-structure histopathologic changes, cell viability, apoptosis cells and cell membrane permeability, locations and expressions of AQP1 and AQP3 and matrix were detected in the cartilage or in the chondrocytes of knee. IL-1β could reduce the chondrocytes viability, increase the apoptosis cells, and also impair the cell membrane and organelles. IL-1β significantly induced the up-regulation of AQP1 and AQP3 in the chondrocytes. In the chondrocytes, AQPs were mainly clustered in both membrane and perinuclear region of cytoplasm, while higher AQPs were detected in the superficial and middle layers of the cartilage. With the up-regulation of AQPs, the cartilage matrix was considerably decreased in both the chondrocytes and in the osteoarthritis cartilage. In the early osteoarthritis rat model, serum and synovial fluid confirmed that higher IL-1β could increase the expressions of AQPs, and decrease the cartilage matrix in both the chondrocytes and the cartilage.

Conclusions

Inflammatory cytokine IL-1β via up-regulation of AQPs caused the abnormal metabolism of water transport and loss of the cartilage matrix in the chondrocytes, and ultimately exacerbated the pathogenesis of early osteoarthritis. Therefore, AQPs may be a candidate therapeutic target for prevention and treatment of osteoarthritis.

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